miRNA biomarkers for radiation biodosimetry

ABSTRACT

Disclosed herein are miRNA biomarkers and methods for measuring exposure of a mammalian subject to ionizing radiation using a cell-free biological sample. Also disclosed are dosimeters and methods for triaging and treating a subject exposed to ionizing radiation.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims benefit of U.S. patent application Ser. No.14/120,289, filed May 14, 2014, which claims benefit of U.S. ProvisionalApplication No. 61/823,063, filed May 14, 2013, both of which are herebyincorporated herein by reference in their entirety.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

This invention was made with Government Support under Grant No.U19AI067798-09 awarded by the National Institutes of Health. TheGovernment has certain rights in the invention.

BACKGROUND

Management of radiological causalities that could occur from naturalcalamities, failures in operational safety mechanisms of nuclear powerplants, or even a terrorist attack require immediate intervention fromemergency responders and medical personnel. The damage caused by ameltdown can be catastrophic as it could release large amounts ofradiation that quickly affects the environment and the health ofsurrounding population. Recent events involving the Fukushima Daiichinuclear reactor have shown the unfortunate and immediate dangers posedby accidental radiation exposure. Nuclear exposure management protocolsinclude rapid dose assessment for the affected population andidentification of the individuals who require immediate medicalattention. Development of robust biomarkers based on an individual'sbiological response is crucial for accurate assessment of the level ofexposure and making important medical decisions. A personalizedassessment will allow evaluation of an individual's physiologicalresponse to radiation damage. The calculated LD₅₀ for humans exposed tototal body irradiation is in the range of 4.0 to 4.5 Gy and the doserange at which supportive care will be effective is narrow. Therefore,development of biomarkers for fast and accurate dose assessment iscritical. Moreover, an individual's response varies depending on manyconfounding factors, such as immune status, age and genetics. Thesefactors will ultimately determine a person's apparent response toexposure, and in some cases victims may not immediately exhibit visiblesigns of radiation damage. Therefore, physical dosimetry alone, and theavailable protein markers such as cytokines, have limitations toaccurately estimate the dose and response of an individual.

Acute effects (Acute Radiation Syndromes, ARS) manifest themselves asHematopoietic, Gastrointestinal (GI), and Cerebrovascular syndromes.Studies have shown that individuals exposed to an intermediate dose (5-8Gy) could die within a few weeks due to GI syndrome. Lower doses (2-5Gy) that are not immediately lethal but compromise the hematopoieticsystem can increase susceptibility to infection and death within monthsif supportive care is not provided in time [Waselenko J K, et al. (2004)Ann Intern Med 140:1037-1051; MacNaughton W K (2000) Aliment PharmacolTher 14: 523-528; Hall E J, et al. (2012) Radiobiology for theRadiologist. Seventh Edition: 193-200; Singh V K, et al. (2009) ExpHematol 38: 61-70; Hanson W R, et al. (1984) Radiat Res 100: 290-297;Shimizu Y, et al. (2010) BMJ 340: b5349]. In addition, several of thevictims who show little or no signs of acute radiation sickness couldfind themselves dealing with late effects in the form of cancer,pulmonary fibrosis, and chronic or progressive heart and kidneydiseases. Epidemiological studies on survivors of the Hiroshima andNagasaki A-bombs and Chernobyl nuclear accident showed an increasedincidence of various cancers and cardiovascular diseases [Shimizu Y, etal. (2010) BMJ 340: b5349; Preston D L, et al. (2003) Radiat Res 160:381-407]. Thus, development of biomarkers capable of accuratelyestimating the dose absorbed is important for identifying theindividuals at risk for acute as well as late effects. Understanding thedose exposed can help in the making of medical decisions and timelyadministration of immune-modulators and mitigators. Development of suchbiomarkers can also help understand the response and toxicity inpatients receiving therapeutic radiation, particularly for those whoreceive total body irradiation as a preparative step for bone marrowtransplantation.

Over the last several years, there have been attempts to estimate theradiation dose exposed using hematological, biochemical, and cytogeneticparameters [Blakely W F, et al. (2010) Health Phys 99 Suppl 5: S184-191;Ossetrova N I, et al. (2010) Health Phys 98:204-208; Blakely W F, et al.(2010) Health Phys 98: 153-159]. Several protein markers such asC-reactive protein, amylase, and cytokines, such as transforming growthfactors, have been investigated for their potential as biodosimeters[Blakely W F, et al. (2010) Health Phys 98: 153-159]. These proteinmarkers, however, have large inter-individual variations; the readoutsare indirect and fluctuate as a result of common variables such asinflammation and infection [Blakely W F, et al. (2010) Health Phys 99Suppl 5: S184-191; Blakely W F, et al. (2010) Health Phys 98: 153-159].Currently, lymphocyte depletion kinetics, clinical observation, and thedicentric chromosome (DC) assay are used for post exposure doseassessment. Lymphocyte depletion analysis requires repeated measurementsover a prolonged period of time and the DC assay is highly technicallyinvolved and labor intensive [Blakely W F, et al. (2010) Health Phys 99Suppl 5: S184-191; Chng W J, et al. (2004) Clin Diagn Lab Immunol 11:168-173]. Therefore, there are needs for identification of biomarkersthat are sensitive to incremental changes in dose, are robust and stablefor days after exposure, and repeatedly assayable in a non-invasive orminimally invasive manner.

SUMMARY

Disclosed herein are compositions and methods for measuring exposure ofa mammalian subject to ionizing radiation. The methods generally involvedetermining in a cell-free biological sample (e.g., serum or plasma)from the subject the levels of at least one radiation-sensitive miRNAwhose blood levels are radiation dose- and time-dependent. The methodcan further involve determining in the sample the levels of at least oneinternal control miRNA whose blood levels are not radiation dose- andtime-dependent. These internal control miRNA levels can then be used tonormalize the radiation-sensitive miRNA levels. In some embodiments, thenormalized levels of radiation-sensitive miRNA in the sample are ameasure of the ionizing radiation exposure by the mammalian subject.

Examples of radiation-sensitive miRNA disclosed herein include let-7c,miR-15b, miR-21, miR-25, miR-29a, miR-126-3p, miR-142-3p, miR-144-3p,miR-146a, miR-150, miR-191-5p, miR-192, miR-200b, miR-486, miR-574-5p,and miR-762.

In some embodiments, the radiation-sensitive miRNA is organ-specific andtherefore useful for effectively triaging a subject after radiationexposure to determine which organs have been affected.Radiation-sensitive miRNA are disclosed that are specific forhematological, pulmonary, or gastrointestinal effects from ionizingradiation exposure. For example, miR-150 levels are shown to be specificfor hematological effects of radiation on stem cell depletion andrecovery in the bone marrow. In addition, miR-574-5p levels are shown tobe specific for gastrointestinal effects from ionizing radiationexposure. The miRNAs let-7c, miR-15b, miR-21, miR-25, miR-29a,miR-126-3p, miR-142-3p, miR-144-3p, miR-146a, miR-191-5p, miR-192,miR-200b, and miR-486 are shown to be specific for pulmonary effects.These miRNA can in some cases also indicate the progression of injury tothe lungs, including tissue damage that occurs in the first few daysafter exposure (miR-200b, miR-191-5p, miR-144-3p, miR-142-3p, miR-192),inflammatory response and injury that occurs after a couple of weeks(miR-21, miR-29a, miR-126-3p, let-7c, miR-191-5p, miR-15b), andPneumonitis that occurs about eight weeks after exposure (miR-146a,miR-486, miR-25, miR-192).

Examples of miRNAs whose levels are not sensitive to radiation exposureand therefore can be used as internal controls include miR-30a, miR-23a,miR130b, and miR-302d-3p.

In some embodiments, the disclosed radiation-sensitive miRNAs arepresent in blood cells. Therefore, contamination of miRNA from bloodcells, e.g., by hemolysis, can mask miRNAs that are organ specific andthe result of radiation exposure. Therefore, in some embodiments, thedisclosed method can further involve determining in the sample thelevels of at least one hemolysis control miRNA whose presence in thesample is an indication of hemolysis contamination. In theseembodiments, hemolysis contamination can be an indication that thesample should be discarded. Examples of miRNAs whose levels are anindication of hemolysis contamination include miR-451, miR-16, miR-25,miR-106b, let-7g, and miR-93.

To control for variances in the starting material as well as theefficiency of RNA extraction steps used for miRNA measurements, knownamounts of spike-in controls can be used to control for thesevariations. The disclosed method can therefore also involve spiking thesample with known amounts of at least one oligonucleotide, anddetermining in the sample levels of the at least one oligonucleotide tofurther normalize the radiation-sensitive miRNA levels. Examples ofsuitable oligonucleotides include synthetic microRNAs.

The disclosed methods can involve triaging a subject using the disclosedmicroRNA as a dosimeter of radiation exposure, and then selecting anappropriate therapy for the subject depending on the exposure. Forexample, in some cases, the method involves treating the mammaliansubject for radiation poisoning if the normalized levels ofradiation-sensitive miRNA in the sample indicate exposure by the subjectto remediable doses of ionizing radiation. For example, the subject canbe treated with hematopoietic stem cell transplant, blood transfusion,or administration of growth factors, such as GM-CSF (Neupogen), withinfew days of whole body exposure a significant dose (e.g., 2 Gy andabove) or a partial body exposure to a significant dose (e.g., 4 Gy andabove). Alternatively, the method can involve treating the mammaliansubject with palliative measures if the normalized levels ofradiation-sensitive miRNA in the sample indicate exposure by the subjectto irremediable doses of ionizing radiation.

Also disclosed is a radiation dosimeter that contains a plurality ofoligonucleotides configured to measure levels of the disclosed microRNA.For example, the dosimeter can contain oligonucleotides configured tomeasure levels of at least one radiation-sensitive miRNA selected fromthe group consisting of let-7c, miR-15b, miR-21, miR-25, miR-29a,miR-126-3p, miR-142-3p, miR-144-3p, miR-146a, miR-150, miR-191-5p,miR-192, miR-200b, miR-486, miR-574-5p, and miRNA-762. For example, theat least one radiation-sensitive miRNA can comprise miR-150 to detecthematological effects of the radiation exposure. The at least oneradiation-sensitive miRNA can also comprise miR-574-5p to detectgastrointestinal effects of the radiation exposure. The at least oneradiation-sensitive miRNA can also comprise and at least one miRNAselected from the group consisting of let-7c, miR-15b, miR-21, miR-25,miR-29a, miR-126-3p, miR-142-3p, miR-144-3p, miR-146a, miR-191-5p,miR-192, miR-200b, and miR-486 to detect pulmonary effects of theradiation exposure.

The dosimenter can also contain oligonucleotides configured to measurelevels of at least one internal control miRNA selected from the groupconsisting of miR-30a, miR-23a, miR-130b and miR-302d. The dosimentercan also contain oligonucleotides configured to measure levels of atleast one hemolysis control selected from the group consisting ofmiR-451, miR-16, miR-25, miR-106b, let-7g, and miR-93.

The details of one or more embodiments of the invention are set forth inthe accompanying drawings and the description below. Other features,objects, and advantages of the invention will be apparent from thedescription and drawings, and from the claims.

DESCRIPTION OF DRAWINGS

FIG. 1A is a gel image showing the integrity of RNA isolated from twomouse serum samples. FIG. 1B shows densitometry traces used to quantifyand compare the relative abundance of various small RNAs.

FIGS. 2A and 2B are lists of miRNAs detected in 20 μl serum from micestrains CBA/J (FIG. 2A) and C57BL/6 (FIG. 2B), arranged in their orderof abundance (%) based on average signal (counts) detected. FIG. 2C is apartial list of miRNAs detected in rhesus monkey serum.

FIGS. 3A to 3H are a series of bar graphs measuring levels (counts) ofmiRNA-451 (FIG. 3A), miRNA-16 (FIG. 3B), miRNA-25 (FIG. 3C), miRNA-106b(FIG. 3D), let-7g (FIG. 3E), miRNA-20a+20b (FIG. 3F), miRNA-93 (FIG.3G), and miRNA-23a (FIG. 3H) derived from red blood cells as a functionof increasing levels (+) of hemolysis.

FIG. 4A is a heat map generated from the actual counts for 88 miRNAsdetected in serum. FIG. 4B is a heat map showing variations in a panelof 18 radio-responsive miRNAs, identified by ANOVA with a cutoff p-valueof 0.05. FIG. 4C is a dendrogram with a panel of markers identified withcoefficient of variance across samples with a cutoff value of 0.4. FIG.4D is a heat map showing an overlapping set of miRNAs from ANOVA and CV.

FIGS. 5A to 5D are bar graphs showing analysis of fold variations ofselected serum miRNA biomarkers with a clear dose response. Histogramsshow variations in the fluorescent counts detected in the nCounter®multiplex assay, plotted against treatment. The counts obtained afternormalization using multiple spike-in oligos were plotted for individualanimals. FIG. 5A shows the dose dependent depletion of serum miRNA-150at 24 hrs (p-values: 1 Gy-0.0164, 2 Gy-0.0191, 4 Gy-0.0026, 6 Gy-0.0001,8 Gy-0.0001). FIG. 5B shows counts from a non-responsive moleculemiRNA-23a, comparable to that of miRNA-150 in control animals. FIGS. 5Cand 5D show radiation induced increase in miRNA-200b and miRNA-762(p-values, miRNA-200b:1 Gy-0.7172, 2 Gy-0.4193, 4 Gy-0.4231, 6Gy-0.0421, 8 Gy-0.0296; miRNA-762:1 Gy-0.4061, 2 Gy-0.1675, 4 Gy-0.0324,6 Gy-0.3139, 8 Gy-0.001).

FIGS. 6A and 6B show dose and time dependent depletion of miRNA-150 inanimals exposed to 1, 2, 4, 6 and 8 Gy with reference to controlsanalyzed at 24 hrs (FIG. 6A) and 48 hrs (FIG. 6B). Statistical analysiswas performed using an unpaired two-tailed students t-test (*)=p<0.05;(**)=p<0.005; (***)=p<0.0005. FIG. 6C shows kinetics of depletion ofmiRNA-150 as a function of dose and time relative to respectivecontrols.

FIG. 7A is a heat map generated using the normalized data for 88 miRNAsdetected in serum from four each of control and irradiated animalscollected 24 hrs (2×2 Gy=4 Gy), 48 hrs (4×2=8 Gy) and 72 hrs (6×2 Gy=12Gy). FIG. 7B is a scheme of the fractionation schedule. FIG. 7C is aheat map for a panel of 8 miRNAs selected from ANOVA with a cutoffp-value of 0.05.

FIGS. 8A to 8D are bar graphs showing variations in the counts ofmiRNA-150 (FIG. 8A), miRNA-23a (FIG. 8B), miRNA-200b (FIG. 8C), andmiRNA-762 (FIG. 8D) following fractionated radiation. The fluorescentcounts obtained after normalization were plotted for individual animalswith the dose and time as given. FIG. 8A shows the dose dependentdepletion of serum miRNA-150 at different time points during and afterfractionation (p-values: 4 Gy-0.0003, 8 Gy-0.0001, 12 Gy-0.0001). FIG.8B shows counts from a non-responsive molecule miRNA-23a (control).FIGS. 8C and 8D shows radiation induced increases in miRNA-200b(p-values 4 Gy-0.014, 8 Gy-0.0047, 12 Gy 0.0027) and miRNA-762.

FIG. 9A illustrates the mechanism of release of miRNAs to blood stream.

FIG. 9B shows miR-150 dose response after 48 hrs by nanoString™ andqRT-PCR, normalized with spike-in oligos; FIGS. 9C and 9D show thedose/time response of miR-150 in mouse serum (FIG. 9C) and rhesus monkeyplasma (FIG. 9D). (*NHP-Rhesus macaques: Sample courtesy: ChromoLogicLLC).

FIG. 10A shows a sample set up for gut/whole thorax exposure. FIG. 10Bshows the kinetics of miR-150 after gut irradiation (n=3); FIGS. 10C and10D show miR-150 kinetics after whole thorax lung irradiation (WTLI) inmouse (FIG. 10C, n=6) and in rats (FIG. 10D, n=4). Two sets of animalswere used to bleed at early time points.

FIGS. 11A to 11E show kinetics of serum miR-192 (FIGS. 11A to 11C) andmiR-21 (FIGS. 11D and 11E) after WTLI (12 Gy) and Gut IR (12 Gy).Multiplex nCounter® assay was used to compare miRNAs in serum separatedfrom blood collected on Day 1, 3, 5, Week 1, 2, and 4 after irradiation(n=6). Samples from age matched unirradiated animals were used ascontrol. Counts (expression level) of the miRNAs in lung tissue also areshown.

FIG. 12 is a heatmap showing results of 6 marker panel (and 2 controls)for plasma collected from rhesus monkeys that received 9 Gy or 11.5 Gywhole thorax irradiation (WTI).

FIGS. 13A to 13C are bar graphs showing miR-191-5p (FIG. 13A),miR-144-3p (FIG. 13B), and miR-302-3p (FIG. 13C) expression as afunction of WTI dose and time.

FIGS. 14A to 14C are bar graphs showing miR-142-3p (FIG. 14A),miR-126-3p (FIG. 14B), and let-7g-5p (FIG. 14C) expression as a functionof WTI dose and time.

FIGS. 15A to 15N are bar graphs showing serum (FIGS. 15A, 15C, 15E, 15G,15I, 15K, 15M) and lung (FIGS. 15B, 15D, 15F, 15H, 15J, 15L, 15N) levelsof miR-150 (FIGS. 15A, 15B), miR-21 (FIGS. 15C, 15D), miR-200b (FIGS.15E, 15F), miR-29a (FIGS. 15G, 15H), miR-146a (FIGS. 15I, 15J),miR-126-3p (FIGS. 15K, 15L), and miR-192 (FIGS. 15M, 15N) after WTI.FIG. 15O shows serum levels of miR-192 after gut irradiation.

DETAILED DESCRIPTION

Disclosed are miRNA biomarkers which may be used to accurately measureradiation exposure levels by a subject. In addition, methods fortriaging and treating radiation exposure, and radiation dosimeters areprovided. In some embodiments, the methods entail detection ofextracellular, circulating miRNAs in a suitable sample, preferablyblood, plasma, serum, urine, or saliva.

In some embodiments, the biological sample used for determining thelevel of one or more miRNA biomarkers is a sample containing circulatingmiRNAs, e.g., extracellular miRNAs. Circulating miRNAs include miRNAs incells (cellular miRNA), extracellular miRNAs in microvesicles(microvesicle-associated miRNA), and extracellular miRNAs that are notassociated with cells or microvesicles (extracellular, non-vesicularmiRNA).

Extracellular miRNAs freely circulate in a wide range of bodily fluids.Accordingly, in some embodiments, the biological sample used fordetermining the level of one or more miRNA biomarkers is a bodily fluid,such as blood, fractions thereof, serum, plasma, urine, saliva, tears,sweat, semen, vaginal secretions, lymph, bronchial secretions, or CSF.In some embodiments, the sample is a sample that is obtainednon-invasively. In some embodiments, the sample is obtained from abodily fluid other than CSF. In some embodiments, the biological sampleused for determining the level of one or more miRNA biomarkers maycontain cells. In other embodiments, the biological sample may be freeor substantially free of cells (e.g., a serum or plasma sample). Thesample may likewise be free or substantially free of microvesicles. Forexample, a sample that is free or substantially free of microvesicles isone in which the microvesicle content of the sample is sufficiently lowto avoid interfering with the ability to accurately determine the levelof non-vesicular miRNAs in the sample.

The level of one or more miRNA biomarkers in a biological sample may bedetermined by any suitable method. Any reliable method for measuring thelevel or amount of miRNA in a sample may be used. Generally, miRNA canbe detected and quantified from a sample (including fractions thereof),such as samples of isolated RNA by various methods known for mRNAdetection, including, for example, amplification-based methods (e.g.,Polymerase Chain Reaction (PCR), Real-Time Polymerase Chain Reaction(RT-PCR), Quantitative Polymerase Chain Reaction (qPCR), rolling circleamplification, etc.), hybridization-based methods (e.g., hybridizationarrays (e.g., microarrays), NanoString™ analysis, Northern Blotanalysis, branched DNA (bDNA) signal amplification, and in situhybridization), and sequencing-based methods (e.g. next-generationsequencing methods, for example, using the Illumina or IonTorrentplatforms). Other exemplary techniques include ribonuclease protectionassay (RPA) and mass spectroscopy.

In some embodiments, RNA is converted to DNA (cDNA) prior to analysis.cDNA can be generated by reverse transcription of isolated miRNA usingconventional techniques. miRNA reverse transcription kits are known andcommercially available. Examples of suitable kits include, but are notlimited to the mirVana TaqMan® miRNA transcription kit (Ambion, Austin,Tex.), and the TaqMan® miRNA transcription kit (Applied Biosystems,Foster City, Calif.). Universal primers, or specific primers, includingmiRNA-specific stem-loop primers, are known and commercially available,for example, from Applied Biosystems. In some embodiments, miRNA isamplified prior to measurement. In other embodiments, the level of miRNAis measured during the amplification process. In still otherembodiments, the level of miRNA is not amplified prior to measurement.Some exemplary methods suitable for determining the level of miRNA in asample are described in greater detail below. These methods are providedby way of illustration only, and it will be apparent to a skilled personthat other suitable methods may likewise be used.

Many amplification-based methods exist for detecting the level of miRNAnucleic acid sequences, including, but not limited to, PCR, RT-PCR,qPCR, and rolling circle amplification. Other amplification-basedtechniques include, for example, ligase chain reaction, multiplexligatable probe amplification, in vitro transcription (IVT), stranddisplacement amplification, transcription-mediated amplification, RNA(Eberwine) amplification, and other methods that are known to personsskilled in the art.

A typical PCR reaction includes multiple steps, or cycles, thatselectively amplify target nucleic acid species: a denaturing step, inwhich a target nucleic acid is denatured; an annealing step, in which aset of PCR primers (i.e., forward and reverse primers) anneal tocomplementary DNA strands, and an elongation step, in which athermostable DNA polymerase elongates the primers. By repeating thesesteps multiple times, a DNA fragment is amplified to produce anamplicon, corresponding to the target sequence. Typical PCR reactionsinclude 20 or more cycles of denaturation, annealing, and elongation. Inmany cases, the annealing and elongation steps can be performedconcurrently, in which case the cycle contains only two steps. A reversetranscription reaction (which produces a cDNA sequence havingcomplementarity to a miRNA) may be performed prior to PCR amplification.Reverse transcription reactions include the use of, e.g., a RNA-basedDNA polymerase (reverse transcriptase) and a primer. Kits forquantitative real time PCR of miRNA are known, and are commerciallyavailable. Examples of suitable kits include, but are not limited to,the TaqMan® miRNA Assay (Applied Biosystems) and the mirVana™ qRT-PCRmiRNA detection kit (Ambion). The miRNA can be ligated to a singlestranded oligonucleotide containing universal primer sequences, apolyadenylated sequence, or adaptor sequence prior to reversetranscriptase and amplified using a primer complementary to theuniversal primer sequence, poly(T) primer, or primer comprising asequence that is complementary to the adaptor sequence.

In some instances, custom qRT-PCR assays can be developed fordetermination of miRNA levels. Custom qRT-PCR assays to measure miRNAsin a biological sample, e.g., a body fluid, can be developed using, forexample, methods that involve an extended reverse transcription primerand locked nucleic acid modified PCR. Custom miRNA assays can be testedby running the assay on a dilution series of chemically synthesizedmiRNA corresponding to the target sequence. This permits determinationof the limit of detection and linear range of quantitation of eachassay. Furthermore, when used as a standard curve, these data permit anestimate of the absolute abundance of miRNAs measured in biologicalsamples.

Amplification curves may optionally be checked to verify that Ct valuesare assessed in the linear range of each amplification plot. Typically,the linear range spans several orders of magnitude. For each candidatemiRNA assayed, a chemically synthesized version of the miRNA can beobtained and analyzed in a dilution series to determine the limit ofsensitivity of the assay, and the linear range of quantitation. Relativeexpression levels may be determined, for example, according to the2(−ΔΔC(T)) Method.

In some embodiments, two or more miRNAs are amplified in a singlereaction volume. For example, multiplex q-PCR, such as qRT-PCR, enablessimultaneous amplification and quantification of at least two miRNAs ofinterest in one reaction volume by using more than one pair of primersand/or more than one probe. The primer pairs comprise at least oneamplification primer that specifically binds each miRNA, and the probesare labeled such that they are distinguishable from one another, thusallowing simultaneous quantification of multiple miRNAs.

Rolling circle amplification is a DNA-polymerase driven reaction thatcan replicate circularized oligonucleotide probes with either linear orgeometric kinetics under isothermal conditions. In the presence of twoprimers, one hybridizing to the (+) strand of DNA, and the otherhybridizing to the (−) strand, a complex pattern of strand displacementresults in the generation of over 10⁹ copies of each DNA molecule in 90minutes or less. Tandemly linked copies of a closed circle DNA moleculemay be formed by using a single primer. The process can also beperformed using a matrix-associated DNA. The template used for rollingcircle amplification may be reverse transcribed. This method can be usedas a highly sensitive indicator of miRNA sequence and expression levelat very low miRNA concentrations.

miRNA may also be detected using hybridization-based methods, includingbut not limited to hybridization arrays (e.g., microarrays), NanoString™analysis, Northern Blot analysis, branched DNA (bDNA) signalamplification, and in situ hybridization.

Microarrays can be used to measure the expression levels of largenumbers of miRNAs simultaneously. Microarrays can be fabricated using avariety of technologies, including printing with fine-pointed pins ontoglass slides, photolithography using pre-made masks, photolithographyusing dynamic micromirror devices, ink-jet printing, or electrochemistryon microelectrode arrays. Also useful are microfluidic TaqManLow-Density Arrays, which are based on an array of microfluidic qRT-PCRreactions, as well as related microfluidic qRT-PCR based methods.

In one example of microarray detection, various oligonucleotides (e.g.,200+5′-amino-modified-C6 oligos) corresponding to human sense miRNAsequences are spotted on three-dimensional CodeLink slides (GEHealth/Amersham Biosciences) at a final concentration of about 20 μM andprocessed according to manufacturer's recommendations. First strand cDNAsynthesized from 20 μg TRIzol-purified total RNA is labeled withbiotinylated ddUTP using the Enzo BioArray end labeling kit (Enzo LifeSciences Inc.). Hybridization, staining, and washing can be performedaccording to a modified Affymetrix Antisense genome array protocol.

Axon B-4000 scanner and Gene-Pix Pro 4.0 software or other suitablesoftware can be used to scan images. Non-positive spots after backgroundsubtraction, and outliers detected by the ESD procedure, are removed.The resulting signal intensity values may be normalized to per-chipmedian values and then used to obtain geometric means and standarderrors for each miRNA. Each miRNA signal can be transformed to log base2, and a one-sample t test can be conducted. Independent hybridizationsfor each sample can be performed on chips with each miRNA spottedmultiple times to increase the robustness of the data.

Microarrays can be used for the expression profiling of miRNAs indiseases. For example, RNA can be extracted from a sample and,optionally, the miRNAs are size-selected from total RNA. Oligonucleotidelinkers can be attached to the 5′ and 3′ ends of the miRNAs and theresulting ligation products are used as templates for an RT-PCRreaction. The sense strand PCR primer can have a fluorophore attached toits 5′ end, thereby labeling the sense strand of the PCR product. ThePCR product is denatured and then hybridized to the microarray. A PCRproduct, referred to as the target nucleic acid that is complementary tothe corresponding miRNA capture probe sequence on the array willhybridize, via base pairing, to the spot at which the, capture probesare affixed. The spot will then fluoresce when excited using amicroarray laser scanner.

The fluorescence intensity of each spot is then evaluated in terms ofthe number of copies of a particular miRNA, using a number of positiveand negative controls and array data normalization methods, which willresult in assessment of the level of expression of a particular miRNA.

Total RNA containing the miRNA extracted from a body fluid sample canalso be used directly without size-selection of the miRNAs. For example,the RNA can be 3′ end labeled using T4 RNA ligase and afluorophore-labeled short RNA linker. Fluorophore-labeled miRNAscomplementary to the corresponding miRNA capture probe sequences on thearray hybridize, via base pairing, to the spot at which the captureprobes are affixed. The fluorescence intensity of each spot is thenevaluated in terms of the number of copies of a particular miRNA, usinga number of positive and negative controls and array data normalizationmethods, which will result in assessment of the level of expression of aparticular miRNA.

Several types of microarrays can be employed including, but not limitedto, spotted oligonucleotide microarrays, pre-fabricated oligonucleotidemicroarrays or spotted long oligonucleotide arrays.

miRNAs can also be detected without amplification using the nCounter®Analysis System (NanoString™ Technologies, Seattle, Wash.). Thistechnology employs two nucleic acid-based probes that hybridize insolution (e.g., a reporter probe and a capture probe). Afterhybridization, excess probes are removed, and probe/target complexes areanalyzed in accordance with the manufacturer's protocol. nCounter® miRNAassay kits are available from NanoString™ Technologies, which arecapable of distinguishing between highly similar miRNAs with greatspecificity. miRNAs can also be detected using branched DNA (bDNA)signal amplification (see, for example, Urdea, Nature Biotechnology(1994), 12:926-928). miRNA assays based on bDNA signal amplification arecommercially available. One such assay is the QuantiGene® 2.0 miRNAAssay (Affymetrix, Santa Clara, Calif.).

Northern Blot and in situ hybridization may also be used to detectmiRNAs. Suitable methods for performing Northern Blot and in situhybridization are known in the art.

Advanced sequencing methods can likewise be used as available. Forexample, miRNAs can be detected using Illumina® Next GenerationSequencing (e.g., Sequencing-By-Synthesis or TruSeq methods, using, forexample, the HiSeq, HiScan, GenomeAnalyzer, or MiSeq systems (Illumina,Inc., San Diego, Calif.)). miRNAs can also be detected using Ion TorrentSequencing (Ion Torrent Systems, Inc., Gulliford, Conn.), or othersuitable methods of semiconductor sequencing.

Mass spectroscopy can also be used to quantify miRNA using RNasemapping. Isolated RNAs can be enzymatically digested with RNAendonucleases (RNases) having high specificity (e.g., RNase Tl, whichcleaves at the 3′-side of all unmodified guanosine residues) prior totheir analysis by MS or tandem MS (MS/MS) approaches. The first approachdeveloped utilized the on-line chromatographic separation ofendonuclease digests by reversed phase HPLC coupled directly to ESTMS.The presence of posttranscriptional modifications can be revealed bymass shifts from those expected based upon the RNA sequence. Ions ofanomalous mass/charge values can then be isolated for tandem MSsequencing to locate the sequence placement of the posttranscriptionallymodified nucleoside.

Matrix-assisted laser desorption/ionization mass spectrometry (MALDI-MS)has also been used as an analytical approach for obtaining informationabout post-transcriptionally modified nucleosides. MALDI-basedapproaches can be differentiated from EST-based approaches by theseparation step. In MALDI-MS, the mass spectrometer is used to separatethe miRNA.

To analyze a limited quantity of intact miRNAs, a system of capillary LCcoupled with nanoESI-MS can be employed, by using a linear iontrap-orbitrap hybrid mass spectrometer (LTQ Orbitrap XL, Thermo FisherScientific) or a tandem-quadrupole time-of-flight mass spectrometer(QSTAR® XL, Applied Biosystems) equipped with a custom-made nanosprayion source, a Nanovolume Valve (Valco Instruments), and a splitless nanoHPLC system (DiNa, KYA Technologies). Analyte/TEAA is loaded onto anano-LC trap column, desalted, and then concentrated. Intact miRNAs areeluted from the trap column and directly injected into a CI 8 capillarycolumn, and chromatographed by RP-HPLC using a gradient of solvents ofincreasing polarity. The chromatographic eluent is sprayed from asprayer tip attached to the capillary column, using an ionizationvoltage that allows ions to be scanned in the negative polarity mode.

Additional methods for miRNA detection and measurement include, forexample, strand invasion assay (Third Wave Technologies, Inc.), surfaceplasmon resonance (SPR), cDNA, MTDNA (metallic DNA; AdvanceTechnologies, Saskatoon, SK), and single-molecule methods such as theone developed by US Genomics. Multiple miRNAs can be detected in amicroarray format using a novel approach that combines a surface enzymereaction with nanoparticle-amplified SPR imaging (SPRI). The surfacereaction of poly(A) polymerase creates poly(A) tails on miRNAshybridized onto locked nucleic acid (LNA) microarrays. DNA-modifiednanoparticles are then adsorbed onto the poly(A) tails and detected withSPRI. This ultrasensitive nanoparticle-amplified SPRI methodology can beused for miRNA profiling at attamole levels.

In certain embodiments, labels, dyes, or labeled probes and/or primersare used to detect amplified or unamplified miRNAs. The skilled artisanwill recognize which detection methods are appropriate based on thesensitivity of the detection method and the abundance of the target.Depending on the sensitivity of the detection method and the abundanceof the target, amplification may or may not be required prior todetection. One skilled in the art will recognize the detection methodswhere miRNA amplification is preferred.

A probe or primer may include standard (A, T or U, G and C) bases, ormodified bases. Modified bases include, but are not limited to, theAEGIS bases (from Eragen Biosciences). In certain aspects, bases arejoined by a natural phosphodiester bond or a different chemical linkage.Different chemical linkages include, but are not limited to, a peptidebond or a Locked Nucleic Acid (LNA) linkage.

In a further aspect, oligonucleotide probes or primers present in anamplification reaction are suitable for monitoring the amount ofamplification product produced as a function of time. In certainaspects, probes having different single stranded versus double strandedcharacter are used to detect the nucleic acid. Probes include, but arenot limited to, the 5′-exonuclease assay {e.g., TaqMan™) probes,stem-loop molecular beacons, stemless or linear beacons, peptide nucleicacid (PNA) Molecular Beacons, linear PNA beacons, non-FRET probes,Sunrise™/AmplifluorB™ probes, stem-loop and duplex Scorpion™ probes,bulge loop probes, pseudo knot probes, cyclicons, MGB Eclipse™ probe(Epoch Biosciences), hairpin probes, PNA light-up probes, anti-primerquench probes, self-assembled nanoparticle probes, andferrocene-modified probes.

In certain embodiments, one or more of the primers in an amplificationreaction can include a label. In yet further embodiments, differentprobes or primers comprise detectable labels that are distinguishablefrom one another. In some embodiments a nucleic acid, such as the probeor primer, may be labeled with two or more distinguishable labels. Insome aspects, a label is attached to one or more probes and has one ormore of the following properties: (i) provides a detectable signal; (ii)interacts with a second label to modify the detectable signal providedby the second label, e.g., FRET (Fluorescent Resonance Energy Transfer);(iii) stabilizes hybridization, e.g., duplex formation; and (iv)provides a member of a binding complex or affinity set, e.g., affinity,antibody-antigen, ionic complexes, hapten-ligand (e.g. biotin-avidin).In still other aspects, use of labels can be accomplished using any oneof a large number of known techniques employing known labels, linkages,linking groups, reagents, reaction conditions, and analysis andpurification methods.

miRNAs can be detected by direct or indirect methods. In a directdetection method, one or more miRNAs are detected by a detectable labelthat is linked to a nucleic acid molecule. In such methods, the miRNAsmay be labeled prior to binding to the probe. Therefore, binding isdetected by screening for the labeled miRNA that is bound to the probe.The probe is optionally linked to a bead in the reaction volume.

In certain embodiments, nucleic acids are detected by direct bindingwith a labeled probe, and the probe is subsequently detected. In oneembodiment of the invention, the nucleic acids, such as amplifiedmiRNAs, are detected using FlexMAP Microspheres (Luminex) conjugatedwith probes to capture the desired nucleic acids. Some methods mayinvolve detection with polynucleotide probes modified with fluorescentlabels or branched DNA (bDNA) detection, for example.

In other embodiments, nucleic acids are detected by indirect detectionmethods. For example, a biotinylated probe may be combined with astreptavidin-conjugated dye to detect the bound nucleic acid. Thestreptavidin molecule binds a biotin label on amplified miRNA, and thebound miRNA is detected by detecting the dye molecule attached to thestreptavidin molecule. In one embodiment, the streptavidin-conjugateddye molecule comprises Phycolink® Streptavidin R-Phycoerythrin(PROzyme). Other conjugated dye molecules are known to persons skilledin the art.

Labels include, but are not limited to: light-emitting,light-scattering, and light-absorbing compounds which generate or quencha detectable fluorescent, chemiluminescent, or bioluminescent signal. Adual labeled fluorescent probe that includes a reporter fluorophore anda quencher fluorophore is used in some embodiments. It will beappreciated that pairs of fluorophores are chosen that have distinctemission spectra so that they can be easily distinguished.

In certain embodiments, labels are hybridization-stabilizing moietieswhich serve to enhance, stabilize, or influence hybridization ofduplexes, e.g., intercalators and intercalating dyes (including, but notlimited to, ethidium bromide and SYBR-Green), minor-groove binders, andcross-linking functional groups.

In other embodiments, methods relying on hybridization and/or ligationto quantify miRNAs may be used, including oligonucleotide ligation (OLA)methods and methods that allow a distinguishable probe that hybridizesto the target nucleic acid sequence to be separated from an unboundprobe. As an example, HARP-like probes may be used to measure thequantity of miRNAs. In such methods, after hybridization between a probeand the targeted nucleic acid, the probe is modified to distinguish thehybridized probe from the unhybridized probe. Thereafter, the probe maybe amplified and/or detected. In general, a probe inactivation regioncomprises a subset of nucleotides within the target hybridization regionof the probe. To reduce or prevent amplification or detection of a HARPprobe that is not hybridized to its target nucleic acid, and thus allowdetection of the target nucleic acid, a post-hybridization probeinactivation step is carried out using an agent which is able todistinguish between a HARP probe that is hybridized to its targetednucleic acid sequence and the corresponding unhybridized HARP probe. Theagent is able to inactivate or modify the unhybridized HARP probe suchthat it cannot be amplified.

A probe ligation reaction may also be used to quantify miRNAs. In aMultiplex Ligation-dependent Probe Amplification (MLPA) technique, pairsof probes which hybridize immediately adjacent to each other on thetarget nucleic acid are ligated to each other driven by the presence ofthe target nucleic acid. In some aspects, MLPA probes have flanking PCRprimer binding sites. MLPA probes are specifically amplified whenligated, thus allowing for detection and quantification of miRNAbiomarkers.

In some embodiments, where a subject is determined by the methodsdescribed herein to have been exposed to high doses of radiation, forexample, enough to result in acute radiation syndrome (ARS), alsodisclosed are methods of treating such subjects for radiation poisoning.

ARS, also known as radiation poisoning, radiation sickness, or radiationtoxicity, is a constellation of health effects which present within 24hours of exposure to high amounts of ionizing radiation. The radiationcauses cellular degradation due to damage to DNA and other key molecularstructures within the cells in various tissues; this destruction,particularly as it affects ability of cells to divide normally, in turncauses the symptoms. The symptoms can begin within one or two hours andmay last for several months. The terms refer to acute medical problemsrather than ones that develop after a prolonged period. The onset andtype of symptoms depends on the radiation exposure. Relatively smallerdoses result in gastrointestinal effects such as nausea and vomiting andsymptoms related to falling blood counts such as infection and bleeding.Relatively larger doses can result in neurological effects and rapiddeath.

Similar symptoms may appear months to years after exposure as chronicradiation syndrome when the dose rate is too low to cause the acute formor as delayed or late effects of the acute exposure. Radiation exposurecan also increase the probability of developing some other diseases,mainly different types of cancers. These diseases are sometimes referredto as radiation sickness, but they are never included in the term acuteradiation syndrome.

Classically acute radiation syndrome can affect the hematopoietic,gastrointestinal, pulmonary, and neurological/vascular systems. Thesesymptoms may or may not be preceded by a prodrome. The speed of onset ofsymptoms is related to radiation exposure, with greater doses resultingin a shorter delay in symptom onset. These presentations presumewhole-body exposure and many of them are markers which are not valid ifthe entire body has not been exposed. Each syndrome requires that thetissue showing the syndrome itself be exposed. The hematopoieticsyndrome requires exposure of the areas of bone marrow actively formingblood elements (i.e., the pelvis and sternum in adults). Theneurovascular symptoms require exposure of the brain. Thegastrointestinal syndrome is not seen if the stomach and intestines arenot exposed to radiation.

The hematopoietic syndrome is marked by a drop in the number of bloodcells, called aplastic anemia. This may result in infections due to lowwhite blood cells, bleeding due to low platelets, and anemia due to lowred blood cells. These changes can be detected by blood tests afterreceiving a whole-body acute dose as low as 0.25 Gy, though they mightnever be felt by the patient if the dose is below 1 Gy. Conventionaltrauma and burns resulting from a bomb blast are complicated by the poorwound healing caused by hematopoietic syndrome, increasing mortality.

The gastrointestinal syndrome often follows absorbed doses of 6-30 Gy.Nausea, vomiting, loss of appetite, and abdominal pain are usually seenwithin two hours. Vomiting in this time-frame is a marker for whole bodyexposures that are in the fatal range above 4 Gy.

The neurovascular syndrome typically occurs at absorbed doses greaterthan 30 Gy, though it may occur at 10 Gy. It presents with neurologicalsymptoms such as dizziness, headache, or decreased level ofconsciousness, occurring within minutes to a few hours, and with anabsence of vomiting. It is invariably fatal.

Radiation induced lung injury can lead to pneumonitis (interstitialpulmonary inflammation) in 1-6 months. This often leads to fibrosis(scaring, collagen deposition) in 6 months to several years. Penumonitisand fibrosis causes respiratory distress and even death. Thoracicirradiation can also lease to lung cancer, breast cancer, lymphoma, etc.

The prodrome (early symptoms) of ARS typically includes nausea andvomiting, headaches, fatigue, fever, and short period of skin reddening.These symptoms may occur at radiation doses as low as 35 rads. Thesesymptoms are common to many illnesses and may not, by themselves,indicate acute radiation sickness.

In the event of a large scale radiation accident or nuclear attack, alarge number of individuals will need to be triaged to determine theirdose of radiation exposure. The disclosed dosimeters and methods can beused to identify individuals who need treatment and those who do not.NIH guidelines indicate that individuals that receive 2 Gy and aboveneed treatment. The DoD indicates that when combined with wound andburn, the critical dose for triage (to treat or not to treat) is 1.5 Gy.

Treatment is generally supportive with the use of antibiotics, bloodproducts, colony stimulating factors, and stem cell transplant asclinically indicated. Symptomatic measures may also be employed.However, it is important to identify the organ(s) affected by theradiation and the dose they received in order to select the appropriatetherapy for the subject.

For example, if it is determined that the hematopoietic system has beenaffected, then the subject can be treated with hematopoietic stem celltransplant, blood transfusion, or administration of growth factors, suchas GM-CSF (Neupogen). In some cases, this treatment should occur withinfew days of whole body exposure of a significant dose (e.g., 2 Gy andabove) or a partial body exposure to a significant dose (e.g., 4 Gy andabove) with significant bone marrow coverage.

If it is determined that the GI track has been affected, the subject canbe treated with intestinal stem cell therapy.

If it is determined that the lung has been affected, the subject can betreated with antioxidants and/or superoxide dismutase mimetics (e.g.AEOL 101050, a metalloporphyrin antioxidant developed by Aeolus).Corticosteroids (e.g. Dexamethasone) can be given to patients to subsidepenumonitis. The disclosed methods can identify individuals at risk ofpneumonitis and thereby allow early administration of corticosteroidsbefore the expression of the issue. Also the panel will help in testingthe efficacy of mitigators.

The treatment of established or suspected infection following exposureto radiation (characterized by neutropenia and fever) is similar to theone used for other febrile neutropenic patients. However, importantdifferences between the two conditions exist. Individuals that developneutropenia after exposure to radiation are also susceptible toirradiation damage in other tissues, such as the gastrointestinal tract,lungs and central nervous system. These patients may require therapeuticinterventions not needed in other types of neutropenic patients. Theresponse of irradiated animals to antimicrobial therapy can beunpredictable, as was evident in experimental studies wheremetronidazole and pefloxacin therapies were detrimental. Antimicrobialsthat reduce the number of the strict anaerobic component of the gutflora (i.e., metronidazole) generally should not be given because theymay enhance systemic infection by aerobic or facultative bacteria, thusfacilitating mortality after irradiation.

An empirical regimen of antimicrobials can be chosen based on thepattern of bacterial susceptibility and nosocomial infections in theaffected area and medical center and the degree of neutropenia.Broad-spectrum empirical therapy with high doses of one or moreantibiotics can be initiated at the onset of fever. These antimicrobialscan be directed at the eradication of Gram-negative aerobic bacilli thataccount for more than three quarters of the isolates causing sepsis.Because aerobic and facultative Gram-positive bacteria (mostlyalpha-hemolytic streptococci) cause sepsis in about a quarter of thevictims, coverage for these organisms may also be needed.

A standardized management plane of febrile, neutropenic patients must bedevised in each institution or agency. Empirical regimens must containantibiotics broadly active against Gram-negative aerobic bacteria(quinolones: i.e., ciprofloxacin, levofloxacin, a third- orfourth-generation cephalosporin with pseudomonal coverage: e.g.,cefepime, ceftazidime, or an aminoglycoside: i.e. gentamicin, amikacin).

The anti-clotting compounds thrombomodulin (Solulin/Recomodulin) andactivated protein C (Xigris) have also been shown to increase bonemarrow cells needed for the production of white blood cells, and improvethe survival rates of mice receiving lethal radiation doses by 40-80%.

Additionally, thrombopoietic activities of the glycosylflavanoidsOrientin and Vicenin can be used to enhance the reconstitution ofcirculating platelets.

In some cases, hydration and palliative care is selected for subjectsdetermined to have been exposed to lethal, irremediable doses ofradiation.

It must be noted that as used herein and in the appended claims, thesingular forms “a,” “an,” and “the” include plural referents unless thecontext clearly dictates otherwise. Thus, for example, reference to “apeptide” includes a plurality of such peptides, reference to “thepeptide” is a reference to one or more peptides and equivalents thereofknown to those skilled in the art, and so forth.

Ranges can be expressed herein as from “about” one particular value,and/or to “about” another particular value. When such a range isexpressed, another embodiment includes from the one particular valueand/or to the other particular value. Similarly, when values areexpressed as approximations, by use of the antecedent “about,” it willbe understood that the particular value forms another embodiment. Itwill be further understood that the endpoints of each of the ranges aresignificant both in relation to the other endpoint, and independently ofthe other endpoint. It is also understood that there are a number ofvalues disclosed herein, and that each value is also herein disclosed as“about” that particular value in addition to the value itself. Forexample, if the value “10” is disclosed, then “about 10” is alsodisclosed. It is also understood that when a value is disclosed that“less than or equal to” the value, “greater than or equal to the value”and possible ranges between values are also disclosed, as appropriatelyunderstood by the skilled artisan. For example, if the value “10” isdisclosed, then “less than or equal to 10” as well as “greater than orequal to 10” is also disclosed. It is also understood that thethroughout the application, data are provided in a number of differentformats, and that these data represent endpoints and starting points,and ranges for any combination of the data points. For example, if aparticular data point “10” and a particular data point 15 are disclosed,it is understood that greater than, greater than or equal to, less than,less than or equal to, and equal to 10 and 15 are considered disclosedas well as between 10 and 15. It is also understood that each unitbetween two particular units is also disclosed. For example, if 10 and15 are disclosed, then 11, 12, 13, and 14 are also disclosed.

The term “subject” refers to any individual who is the target ofadministration or treatment. The subject can be a vertebrate, forexample, a mammal. Thus, the subject can be a human or veterinarypatient. The term “patient” refers to a subject under the treatment of aclinician, e.g., physician.

The term “radiation injury” refers to an injury or damage that is causedby exposure to ionizing radiation. Radiation injury includes but is notlimited to radiation poisoning, radiation sickness, acute radiationsyndrome or chronic radiation syndrome.

The term “ionizing radiation” refers to radiation that has sufficientenergy to eject one or more orbital electrons from an atom or molecule(e.g. a particles, β particles, γ rays, x-rays, neutrons, protons andother particles having sufficient energy to produce ion pairs inmatter).

The term “therapeutically effective” refers to the amount of thecomposition used is of sufficient quantity to ameliorate one or morecauses or symptoms of a disease or disorder. Such amelioration onlyrequires a reduction or alteration, not necessarily elimination.

The term “pharmaceutically acceptable” refers to those compounds,materials, compositions, and/or dosage forms which are, within the scopeof sound medical judgment, suitable for use in contact with the tissuesof human beings and animals without excessive toxicity, irritation,allergic response, or other problems or complications commensurate witha reasonable benefit/risk ratio.

The term “carrier” means a compound, composition, substance, orstructure that, when in combination with a compound or composition, aidsor facilitates preparation, storage, administration, delivery,effectiveness, selectivity, or any other feature of the compound orcomposition for its intended use or purpose. For example, a carrier canbe selected to minimize any degradation of the active ingredient and tominimize any adverse side effects in the subject.

The term “treatment” refers to the medical management of a patient withthe intent to cure, ameliorate, stabilize, or prevent a disease,pathological condition, or disorder. This term includes activetreatment, that is, treatment directed specifically toward theimprovement of a disease, pathological condition, or disorder, and alsoincludes causal treatment, that is, treatment directed toward removal ofthe cause of the associated disease, pathological condition, ordisorder. In addition, this term includes palliative treatment, that is,treatment designed for the relief of symptoms rather than the curing ofthe disease, pathological condition, or disorder; preventativetreatment, that is, treatment directed to minimizing or partially orcompletely inhibiting the development of the associated disease,pathological condition, or disorder; and supportive treatment, that is,treatment employed to supplement another specific therapy directedtoward the improvement of the associated disease, pathologicalcondition, or disorder.

A number of embodiments of the invention have been described.Nevertheless, it will be understood that various modifications may bemade without departing from the spirit and scope of the invention.Accordingly, other embodiments are within the scope of the followingclaims.

EXAMPLES Example 1: Identification of Sensitive Serum microRNABiomarkers for Radiation Biodosimetry

microRNAs (miRNAs) are non-coding RNAs of 19-22 nucleotides that wereoriginally identified as regulators of gene expression by inducingcleavage of their target mRNA or blocking translation through basepairing to partially complementary sequences [Bartel D P (2004) Cell116: 281-297]. miRNAs regulate diverse cellular processes includingdevelopment, proliferation and differentiation, as well as variousdisease progressions [Iorio M V, et al. (2012) EMBO Mol Med 4:143-159].In addition to their roles in post-transcriptional gene regulation,miRNAs in body fluids are proposed and have been assessed as biomarkersfor various physiological responses and pathological stages [Cui W, etal. (2011) PLoS ONE 6: e22988; Scholl V, et al. (2012) Leuk Res36:119-121; Qi P, et al. (2011) PLoS ONE 6: e28486; Weiland M, et al.(2012) RNA Biol 9: 850-859; Cortez M A, et al. (2011) Nat Rev Clin Oncol8: 467-477; Russo F, et al. (2012) PLoS ONE 7: e47786]. Earlier studieshave detected miRNAs in a range of body fluids such as serum, plasma andurine, and miRNAs are relatively stable due to their smaller size andbeing protected in exosomes [Hunter M P, et al. (2008) PLoS ONE 3:e3694;Valadi H, et al. (2007) Nat Cell Biol 9: 654-659]. However, the currentPCR based methods used for evaluation of miRNA in body fluids havelimitations. Because several miRNAs are present in low quantities, PCRbased detection and quantification often requires pre-amplification ofthe template and a higher number of amplification cycles, whichcompromises the reliability of the measurements [Etheridge A, et al.(2011) Mutat Res 717: 85-90]. To circumvent this problem, a digitalamplification-free quantification and comparison method was used [GeissG K, et al. (2008) Nat Biotechnol 26: 317-325] which allowed evaluationof the relative abundance of individual miRNAs in the serum samples anddevelopment of a panel of sensitive biomarkers for radiationbiodosimetry.

Materials and Methods

Animal Studies

For animal studies involving acute single dose exposure, 8-9 week oldMus musculus were used. Male inbred mice (Strains CBA/J and C57BL/6,Jackson Laboratories) were co-housed (five per standard cage) and fed adlibitum. Mice were exposed to total body gamma radiation (TBI) usingGammaCell@40 irradiator (Cesium 2137 Source) at a dose rate of 1.1Gy/min). For each radiation dose (0, 1, 2, 4, 6 and 8 Gy) and time point(24 and 48 hrs) a minimum of five animals were used. Control animalswere sham-exposed. For investigating the effect of fractionated dose, 15animals were exposed to X-rays (in 2 Gy fractions) from a RS-2000Biological Irradiator at a dose rate of 1 Gy/min. All the animalexperiments were done with strict adherence to the institutionalguidelines established and approved by the Ohio State University AnimalCare and Use Committee (Permit number: 2011A00000029).

Blood was collected by submandibular bleeding or by cardiac puncture.Following coagulation (1 hr at room temperature), serum was separatedusing microtainer tubes (BD Biosciences) by centrifugation at 10,000 gfor 10 min, and then frozen at −80° C. RNA was extracted using theQiagen miRNA easy kit following the manufacturer's protocol. miRNAs wereisolated from serum samples collected from 4-5 animals for each timepoints, and samples with high levels of hemolysis were excluded fromanalysis. In a typical isolation procedure, 100 ml serum was used. Afterlysis using QIAzol reagent, 4-20 pg synthetic oligonucleotides (spike-inoligos) Osa-miRNA-414, Cel-miRNA-248, At-miRNA-159a (Integrated DNATechnologies) were added prior to extraction. RNA was eluted in 100 mlwater and concentrated to 20 ml and 3 ml was used for each assay forprofiling using nanoString™ Technologies' multiplexed nCounter®platform. The platform incorporates fluorescent barcodes together with adigital readout for single-molecule imaging [Geiss G K, et al. (2008)Nat Biotechnol 26: 317-325]. It does not involve reverse transcription;instead the technology relies on sequence-specific probes to digitallymeasure miRNA abundance. This hybridization based amplification-freemethod allows processing of multiple samples, comparing and quantifyingthe number of molecules even of low abundance. The spike-in oligos allowa volume and quantity based normalization for detection of even smallchanges in individual miRNAs.

miRNA Expression Profiling

The digital multiplexed nanoString™ nCounter® mouse miRNA expressionassay (nanoString™ Technologies) was performed with 10-30 ng total RNAisolated from a net volume of 20 ml serum as input material. Small RNAsamples were prepared by ligating a specific DNA tag (miR-tag) onto the39 end of each mature miRNA according to the manufacturer's instruction.These tags serve several purposes: they normalize the wide range ofmelting temperatures (Tms) of the miRNAs, provide a template tofacilitate the use of the nanoString™ dual probe system, enable singlebase pair discrimination and specificity of highly homologous miRNAfamily members, and identify each miRNA species. Excess tags wereremoved by restriction digestion at 37° C. Hybridizations were carriedout by combining 5 ml of each miRNA-miRTag sample with 20 ml ofnCounter® Reporter probes in hybridization buffer and 5 ml of nCounter®Capture probes (for a total reaction volume of 30 ml) overnight at 65 uCfor 16-20 hrs. Excess probes were removed using two-step magnetic beadbased purification on the nCounter® Prep Station (NanoStringTechnologies). Abundances of specific target molecules were quantifiedon the nCounter® Digital Analyzer by counting the individual fluorescentbarcodes and assessing the target molecules. For each assay, ahigh-density scan encompassing 600 fields of view was performed. Thedata was collected using the nCounter® Digital Analyzer after takingimages of the immobilized fluorescent reporters in the sample cartridgewith a CCD camera.

Data Analysis

miRNA data analysis was performed using the nSolver™ software analysis,freely available from NanoString Technologies. The serum miRNA profilingdata was normalized using the average signals obtained from threespike-in oligos, and miRNAs that gave significant hybridization signalswere used for downstream analysis. ANOVA was performed with a cutoffp-value of 0.05 to identify a set of miRNAs that had the highestdifference in means across samples. Coefficient of variance acrosssamples was also performed with a cutoff of 0.4 and overlapping sets ofmiRNAs from the above two methods were selected as the most significantset. R software was used for the analysis.

Results

Optimization of Methods for Quantitative Analysis of Serum miRNAs

The digital multiplexed nanoString™ nCounter® mouse miRNA expressionassay was performed on total RNA isolated from 20 ml of serum usuallycontaining a total amount of 10-30 ng of RNA. The nCounter® multiplexplatform is capable of detecting approximately 600 mouse specificmiRNAs, four housekeeping genes and three non-mammalian miRNAs:Osa-miRNA-414, CelmiRNA-248 and At-miRNA-159a. During RNA isolation,synthetic oligonucleotides (spike-in oligos) corresponding toOsamiRNA-414, Cel-miRNA-248 and At-miRNA-159a were included as controlsallowing the normalization of samples. The amounts of spike-in oligoswere optimized by comparing their counts with that of endogenous miRNAsin serum samples. The optimal amount of spike-in oligos fornormalization was identified to be 0.5-2 pg in each reaction. Theinclusion of probes hybridizing to the house keeping genes enabledfurther identification and separate preparations with cellular RNAcontaminations. The optimized method allowed detection of changes inserum miRNAs that are specific to changes in physiological and treatmentconditions, such as response to radiation. The purity and integrity ofthe RNA recovered from serum samples was validated on a small RNAbioanalyzer (FIG. 1A). miRNAs were found to represent 18-22% of totalserum RNA preparations (FIG. 1B).

The nCounter® expression profiling conducted on total RNA isolated frommice serum samples identified 88 miRNAs with high confidence. miRNA-451was found to be the most abundant in serum preparations, contributing to22-23% of total miRNAs (FIG. 2). miRNA-16 ranked second, representing,13%. Analysis of serum samples from a minimum of three animals from eachof the two strains of mice (CBA/J and C57BL/6) showed similar results.Several evolutionarily conserved and functionally significant miRNAs,such as miRNA-150, miRNA-21, miRNA-29a and miRNA-23a, were also detectedin serum samples [Wang B, et al. (2012) Hepatology 56: 186-197; Thum T,et al. (2008) Nature 456: 980-984; Teichler S, et al. (2011) Blood118:1899-1902; Vasilescu C, et al. (2009) PLoS ONE 4: e7405; Zhou B, etal. (2007) Proc Natl Acad Sci USA 104: 7080-7085]. Given the abundanceof miRNA-451 and miRNA-16 in serum, feasibility of using these asendogenous normalizers was investigated the by comparing their signalswith that of spike-in oligos. However, because of the abundance of thesemiRNAs in red blood cells, even a small level of hemolysis was found toskew the results. Therefore, these endogenous markers were not used asbiological normalizers. Furthermore, comparison of samples withincreasing levels of hemolysis enabled identification of additionalmarkers that potentially originating from the lysis of red blood cells.These include miRNA-25, miRNA-106b, let-7g, and miRNA-93 (FIG. 3), whilethe level of miRNA-23a was not increased in samples with higher levelsof hemolysis. Thus, parallel analysis of samples normalized withmultiple controls allowed identification of markers that are specificand sensitive to radiation treatment.

Radiation Dose Dependant Changes in Serum miRNA Profile Following SingleAcute Dose

Using the nCounter® multiplex assay, miRNAs in serum samples fromcontrol and irradiated animals collected 24 hrs after 1, 2, 4, 6 and 8Gy total body irradiation (TBI) were compared. In order to minimizeexperimental error, irradiation, serum collection, RNA isolation, miRNAprofiling, and normalization were done in parallel with controls andtreatment groups. Samples with traces of cellular RNA contamination(with counts of 30 or above for any of the four housekeeping genes) wereexcluded from the analysis. Samples with high levels of hemolysisobserved visually or based on relative abundance of miRNA-451 (23%),miRNA-16 (13%) correlating with increase in miRNA-25, miRNA-106b, let-7g and miRNA-93 were also excluded from analysis.

The relative changes of 88 miRNAs detected in serum samples wereevaluated for their radiation dose dependent changes (FIG. 4A). Changeswere observed in several miRNAs distinguishable from irradiated versuscontrols and between different doses of radiation (FIG. 4B). At first,ANOVA was performed with a cutoff p-value of 0.05 to identify a set ofmiRNAs that had the highest difference in means across samples. Next,the coefficient of variance was calculated with a cutoff of 0.4 (FIG.4C). Finally, an overlapping set of miRNAs from the above two methodswas selected as the most significant and responsive set (FIG. 4D).Several markers were found clustering with specific dose or dose rangeindicating a clear radiation biodosimetry potential.

Selected radiosensitive miRNAs identified from cluster analysis werefurther investigated for their dose and time dependent changes. In orderto evaluate the robustness of the response of each individual marker,the normalized fluorescence counts from individual animals that receivedvarying doses of radiation was plotted (FIG. 5). miRNA-150 wasidentified as a robust radio-responsive serum biomarker, with a cleardose response in all animals compared 24 hrs after radiation (FIG. 5A).A decrease in levels of miRNA-150 was evident even in animals thatreceived 1 Gy radiation, which further decreased with increasing dose(2, 4, 6 and 8 Gy). Molecules that exhibited an increase in their serumlevels after radiation exposure include miRNA-200b and miRNA-762, andthese changes were more pronounced in animals that received higher doses(FIG. 5C, 5D). miRNA-23a, whose counts in controls are comparable tothat of miRNA-150, was used as another control (FIG. 5B).

miRNA-150 was further investigated for its kinetics of depletion bycomparing the dose response at 24 and 48 hrs. A 30% reduction in serummiRNA-150 was observed in animals 24 hrs after 1 Gy total body radiationexposure, which further decreased to 50% by 48 hrs (FIG. 6). A time anddose dependent decrease in serum miRNA-150 was evident with an increasein dose, where a gradual decrease in counts was observed with increasingdose. This further confirms the sensitivity and robustness of this serummarker as a candidate for radiation biodosimetry.

Dose and Time Dependant Changes in miRNAs after Fractionated RadiationExposure

In order to further investigate the biodosimetry potential of theidentified miRNAs in the setting of clinical therapeutic radiation, thechanges in miRNAs in animals exposed to fractionated doses was compared.Mice were exposed to fractionated radiation following a schedulecomparable to that administered to patients receiving total bodyirradiation as preparative regimen prior to bone marrow transplantation.Twelve week old mice were exposed to a total dose of 4, 8 and 12 Gy in 2Gy fractions twice a day. Serum collected at 24 hrs (2×2 Gy=4 Gy), 48hrs (4×2 Gy=8 Gy) and 72 hrs (6×2 Gy=12 Gy) was analyzed for changes inmiRNAs using the multiplex nCounter® platform (FIG. 7). Serum collectedfrom the same animals three weeks prior to radiation exposure was usedto compare their basal levels, and the dose and time dependent changes.Moreover, several of those miRNAs that responded to acute single dosewas found sensitive to fractionated radiation as well. Consistent withdata from single acute dose, about 50% reduction in serum counts formiRNA-150 was observed in mice that received 4 Gy by 24 hrs. A furtherdecrease was observed with higher doses at later time points (FIG. 8).Consistent with the response to single acute dose, markers such asmiRNA-762 and miRNA-200b exhibited an increase in their serum levelsunder conditions of fractionated radiation up to 48 hrs. However, adecrease in miRNA-762 was observed at 72 hours. Overall, the dataestablishes the biodosimetry potential of selected miRNAs underconditions receiving acute single dose as well as fractionatedradiation.

Discussion

The current study has identified several evolutionarily conserved miRNAsresponsive to acute radiation in a dose range relevant to accidentalradiation exposure or clinical radiation therapy. Identification ofserum abundant radio-responsive and non-responsive miRNAs together withspike-in oligos provide a panel of markers and controls for developingradiation biodosimeters. This will aid rapid diagnostic screening toidentify individuals who are at risk of developing acute radiationsyndromes. Accurate dose evaluation is critical for making medicaldecisions and timely administration of mitigators to prevent or reducethe acute and late effects. Individual miRNAs such as miRNA-150 alone orin combination with other markers have the potential to estimate thedose to which the individual was exposed. The majority of serum miRNAmarkers did not respond to radiation, but the hierarchical clusteringhas identified several markers, potentially originating from bloodcells, exhibiting dose- and time-sensitive responses to acute single orfractionated dose. In this study, 24 and 48 hr time points were used,which are realistic time frames to collect blood samples in a scenarioinvolving mass causality from radiation exposure. miRNA-150 depletionkinetics indicate that the response is fast and robust with a nearcomplete depletion in 48-72 hrs with 8 Gy acute dose and 8-12 Gyfractionated dose. The evaluation of the kinetics of depletion ofmiRNA-150 during three days of fractionation, using a schedule followedin a clinical setting, signifies the translational potential of thismarker. In addition to chemo-based approaches, fractionated total bodyirradiation is used for conditioning in patients undergoing bone marrowtransplantation. At the same time, management of hematopoietic injury isa major clinical question in both chemo and radiation based cancertherapies.

miRNA-150 is shown herein to be a sensitive biomarker for damage to thehematopoietic system, which is the most radiosensitive organ/system. Thebiodosimetry potential of miRNA-150 is evident from its time and dosedependent depletion, correlating with lymphocyte depletion kinetics[Waselenko J K, et al. (2004) Ann Intern Med 140:1037-1051; Blakely W F,et al. (2010) Health Phys 99 Suppl 5: S184-191; Goans R E, et al. (1997)Health Phys 72: 513-518]. Moreover, miRNA-150 is abundant in serum(ranked among the top 6 miRNAs in serum), and was found to be sensitiveeven at 1 Gy, the lowest tested dose in the current study. The time anddose response of this marker makes it a potential alternative tocomplete blood counts and lymphocyte depletion kinetics, the currentdiagnostic tools for evaluating radiation response.

Example 2: Organ Specific Biological Response to Radiation

Abstract

A major issue that affects the decision making in triage after radiationaccidents is the heterogeneity due to variations in exposures [Prasanna,P. G., et al. (2010) Radiat Res 173(2):245-53; Rea, M. E., et al. (2010)Health Phys 98(2):136-44]. In a partial body exposure event, dependingon dose and geography of exposure, effect may be restricted to a singleor multiple organs [DiCarlo, A. L., et al. (2011) Disaster Med PublicHealth Prep 5 Suppl 1:S32-44]. As such, ARS follows a deterministiceffect whereby dose effects have distinct clinical outcomes: generally<2 Gy exhibit mild symptoms, 2-6 Gy are primarily hematologic (HE)effects, and above 5-6 Gy gastrointestinal (GI) effects are prominentwhich progress more rapidly [DiCarlo, A. L., et al. (2011) Disaster MedPublic Health Prep 5 Suppl 1:S32-44; Waselenko, J. K., et al. (2004) AnnIntern Med 140(12):1037-51]. Damage to the GI system should be evidentwithin days, however require a relatively higher dose than that neededto affect the HE system. Lung is a relatively sensitive organ; but theeffects will not be apparent for weeks or even months [Garofalo, M., etal. (2014) Health Phys 106(1):56-72]. The current biodosimeters(lymphocyte depletion kinetics and dicentric chromosome assays) read theresponse in hematopoietic system. Because of the differences in thekinetics and latency period, it is difficult to detect and/ordistinguish the effects on non-HE systems. In addition, the thresholdand latency period could differ due to differences in age, immune statusand other underlying conditions.

miRNAs as Radiation Response Markers

miRNAs are small RNA molecules of 20-24 nt long originally identified asregulators of gene expression [Bartel, D. P., et al. (2004) Cell116(2):281-97]. They are abundant in body fluids and hence provideuseful tools for diagnosis by minimally-invasive assay. In body fluidsincluding serum and plasma, miRNAs are protected in exosomes,microparticles, and nucleoprotein complexes. Thus, they are stable atroom temperature for days and even after several freeze-thaw cycles[Mitchell, P. S., et al. (2008) Proc Natl Acad Sci USA 105(30):10513-8].Being small, they are less susceptible to degradation. Levels ofspecific miRNAs in blood can change after radiation by multiple ways.Like in the case of mRNAs, expression level can be altered afterradiation [Templin, T., et al. (2012) Int J Radiat Biol. 87(7):653-62].They can be released with apoptotic bodies and/or by active secretarypathways. It has been shown that processing of the precursors of miRNAscan directly or indirectly be regulated by cytokines such as TumorNecrosis Factor-α (TNFα) and TGFβ1[Barcellos-Hoff, M. H., et al. (1998)Radiat Res 150(5 Suppl):S109-20; Zhu, Y., et al. (2010) Int J Clin ExpMed 3(3):211-22; Davis, B. N., et al. (2008) Nature 454(7200):56-61]that can be altered after radiation. Also, radiation induced activationof ATM kinase can cause alteration of the precursors in miRNAs [Zhang,X., et al., et al. (2011) Mol Cell 41(4):371-83]. Finally, reduction ina particular cell type (e.g. lymphocytes) will result in reducedcirculating exosomes originated from that cell.

miR-150 as a Biodosimeter:

An amplification-free hybridization based nCounter® assay (>600 probes)was used to measure changes in over 80 miRNAs in serum after irradiation(gamma rays, 1.11 Gy/min, from Cs-137 source) [Jacob, N. K., et al.(2013) PLoS ONE 8(2):e57603]). A volume based normalization was usedwith a mixture of three spike-in oligos. Among various evolutionarilyconserved miRNAs, miR-150 was identified as highly sensitive biomarkerwhose serum depletion correlates with radiation dose. miR-150 regulatesB-cell development and is abundant in lymphocytes [Garzon, R., et al.(2008) Curr Opin Hematol 15(4):352-8; Adams, B. D., et al. (2012) CellRep 2(4):1048-60; Xiao, C., et al. (2007) Cell 131(1):146-59; Zhou, B.,et al. (2007) Proc Natl Acad Sci USA 104(17):7080-5; Jiang, X., et al.(2012) Cancer Cell 22(4):524-35; Bezman, N. A., et al. (2011) J Exp Med208(13):2717-31]. In mice that received acute single doses of 1, 2, 4, 6and 8 Gy gamma-rays, a 30%, 38%, 48% 70% and 72% reduction of serummiR-150 was observed at 24 hrs, which was further reduced at later timepoints (FIG. 9B/9C). The results were confirmed by alternative methodssuch as qRT-PCR and RNA sequencing (FIG. 9B). Similar dose and timeresponse were observed in plasma samples from irradiated rhesus monkeys.Time- and dose-dependent decrease in miR-150 was observed following thecritical dose of 2 Gy and a higher dose of 5.5 Gy (FIG. 9D). Significantchange in miR-150 levels was also noted in animals that received 0.5 GyTBI, although response was less dramatic in the acute stage, butincreased at one week post XRT. In the WTLI and gut irradiation models,a partial depletion in miR-150 was noted, however the level returned tobaseline in 3 weeks, suggesting that it is an indicator of bone marrowdamage and/or recovery (FIG. 10).

Identification of Biomarkers Connected with Organ-Specific Responses toXRT:

There are over 2000 miRNAs in mammalian cells and each cell type has adistinct signature with regard to their expression and abundance. Forexample miR-451, miR-142-3p, miR-223, etc. are high in bone marrow andblood cells, while miR-126 and let7 family, miR-29a and others areabundant in lung. HE system and lung constantly release exosomes withtheir respective signatures. Changes in serum miRNAs with distinctsignature and kinetics were observed after WTLI. For example, increasesin miR-21 and miR-29a were observed 2 weeks after WTLI, a time pointwhere inflammation and active release of exosomes or leaking arepredicted [Rube, C. E., et al. (2000) Int J Radiat Oncol Biol Phys47(4):1033-42]. Several of the markers that peaked in the serum at 2weeks were found to be very abundant in lung (FIG. 11, Table 1). Organspecificity was confirmed with parallel analysis failing to detect thesemiRs in serum samples collected from control animals or animals exposedto GI radiation (FIG. 11). Further, several of these miRs are reportedto be altered in lung diseases, or are mechanistically connected toresponses such as lung injury and/or inflammation [Hassan, F., et al.(2012) PLoS ONE 7(11):e50837; Izzotti, A., et al. (2009) Faseb J23(3):806-12; Oglesby, I. K., et al. (2010) J Immunol 184(4):1702-9].Delayed effects of radiation, such as pneumonitis, were evident frommicroCT and MM analysis at around 20 weeks after radiation in severalanimals (data not shown). Dose effects were evident from the differencesin serum markers, latency and incidence of delayed effects, whencompared 8 Gy vs 12 Gy exposed animals. Overall, data from organtargeted/protected irradiation animals led to the development of a panelof miRNA biomarkers that provide references for evaluating organresponses after partial body exposure.

TABLE 1 miRNA markers with distinct response with potential connectionwith organ function, along with several controls. OrganResponse/Connection Serum/Plasma miRs identified Lung 1-3 Tissue/DNAdamage/ miR-200b, miR-191-5p, days Apoptosis/systemic miR-144-3p,miR-142-3p, miR-192 response 2 Inflammatory response/ miR-21, miR-29a,miR-126-3p, weeks Lung injury/leakage let-7c, miR-191-5p, miR-15b,miR-130a, miR-19a 8+ Pneumonitis/progression/ miR-146a, miR-486, miR-25,weeks systemic effects miR-192 HE HE stem cells depletion/ miR-150recovery GI TLR signaling miR-574-5p (6-10 fold increase in NHPs, 5.5 Gy24 h) Controls Hemolysis miR-451, miR-16, miR-106b Internal ControlsmiR-30a, miR-23a, miR130b Cellular RNA Actin, Tubulin, Gapdh, Rpl19contamination Normalizers (spike-ins) At-159a, Cel-248, Osa-414

Example 3: Diagnosis of Radiation Induced Lung Injury, Pneumonitis, andLung Fibrosis

BALB/c mice received 12 Gy whole thorax lung irradiation (WTLI),resulting in pneumonitis and death at 20-22 weeks. Rhesus monkeysreceived 9 Gy or 11.5 Gy WTLI. The 11.5 Gy animals were euthanized dueto pneumonitis at 79-162 days. Serum/Plasma was collected at C-D1, D1,D3, D5, Wk1, Wk2, Wk4, Wk8, Wk12, and C-12 Wk for mice; and D0, D1/2,D5, and D8 for monkeys.

FIG. 12 is a heatmap showing results of 6 marker panel (and 2 controls)for the rhesus monkey-WTLI model.

FIGS. 13A to 13C are bar graphs showing miR-191-5p (FIG. 13A),miR-144-3p (FIG. 13B), and miR-302-3p (FIG. 13C) expression as afunction of WTLI dose and time. miR-191-5p is upregulated in lungexposed to cigarette smoke (targets Nrf2). miR-144-3p is altered inidiopathic pulmonary fibrosis (IPF), cystic fibrosis (CF), etc., andtargets CFTR gene. miR-302-3p was used as an internal control.

FIGS. 14A to 14C are bar graphs showing miR-142-3p (FIG. 14A),miR-126-3p (FIG. 14B), and let-7g-5p (FIG. 14C) expression as a functionof WTLI dose and time. miR-142-3p regulate innate immune responsefunctional regulation of IL-6 in dendritic cells. miR-126-3p expressionis down in CF airway epithelial cells, and regulates innate immuneresponse. let7 family abundant in lung and implicated in lung diseases.

FIGS. 15A to 15X are bar graphs showing serum (FIGS. 15A, 15C, 15E, 15G,15I, 15K, 15M) and lung (FIGS. 15B, 15D, 15F, 15H, 15J, 15L, 15N) levelsof miR-150 (FIGS. 15A, 15B), miR-21 (FIGS. 15C, 15D), miR-200b (FIGS.15E, 15F), miR-29a (FIGS. 15G, 15H), miR-146a (FIGS. 15I, 15J),miR-126-3p (FIGS. 15K, 15L), and miR-192 (FIGS. 15M, 15N) after WTI.FIG. 15O shows serum levels of miR-192 after gut irradiation.

Table 1 shows circulating miRNAs that are indicators of lung injury andare predictors of delayed and late effects.

Unless defined otherwise, all technical and scientific terms used hereinhave the same meanings as commonly understood by one of skill in the artto which the disclosed invention belongs. Publications cited herein andthe materials for which they are cited are specifically incorporated byreference.

Those skilled in the art will recognize, or be able to ascertain usingno more than routine experimentation, many equivalents to the specificembodiments of the invention described herein. Such equivalents areintended to be encompassed by the following claims.

What is claimed is:
 1. A method for measuring exposure of a humansubject to ionizing radiation and administering a treatment methodaccording to results thereof, comprising (a) assaying a blood samplefrom a human subject exposed to radiation to measure the levels ofmiR-150, wherein the blood sample comprises whole blood, serum orplasma; (b) assaying the sample to measure the levels of miR-23a; (c)normalizing the miR-150 levels based specifically on the miR-23a levels;(d) estimating the measure of ionizing radiation exposure from thenormalized miR-150 levels; (e) identifying a human subject exposed to aremediable level of radiation poisoning, and (f) administering to thehuman subject exposed to a remediable dose of radiation poisoning animmune modulator or mitigator according to level of radiation exposure.2. The method of claim 1, wherein the levels of miR150 are a measure ofabsorbed radiation dose and evaluation of hematologic effects fromionizing radiation exposure.
 3. The method of claim 1, furthercomprising assaying the sample to measure the levels of miR-16 whosepresence in the sample is an indication of hemolysis contamination,wherein hemolysis contamination is an indication that the sample shouldbe discarded.
 4. The method of claim 1, further comprising spiking thesample with known amounts of at least one oligonucleotide, anddetermining in the sample levels of the at least oligonucleotide tofurther normalize the miR-150 levels.
 5. The method of claim 1, furthercomprising assaying the sample to measure the levels of miRNA-25 whosepresence in the sample is an indication of hemolysis contamination,wherein hemolysis contamination is an indication that the sample shouldbe discarded.
 6. The method of claim 1, further comprising assaying thesample to measure the levels of miRNA-93 whose presence in the sample isan indication of hemolysis contamination, wherein hemolysiscontamination is an indication that the sample should be discarded. 7.The method of claim 1, further comprising assaying the sample to measurethe levels of miRNA-106b whose presence in the sample is an indicationof hemolysis contamination, wherein hemolysis contamination is anindication that the sample should be discarded.
 8. The method of claim1, further comprising assaying the sample to measure the levels ofmiR-451 whose presence in the sample is an indication of hemolysiscontamination, wherein hemolysis contamination is an indication that thesample should be discarded.
 9. The method of claim 1, wherein the immunemodulator or mitigator is a hematopoietic stem cell transplant,antibiotic, a blood transfusion, or administration of growth factors.10. The method of claim 1, wherein the growth factor is GM-CSF.